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Announcer

And now America's Healthcare Advocate, Cary Hall.

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Cary Hall

Hello, America. Welcome to America's Healthcare Advocates, broadcasting coast to coast across the USA here on the HIA Radio Network. You can find out more about us by going to our website, AmericasHealthcareAdvocate.com. All these shows are posted on your favorite podcast platforms Spotify, SoundCloud, Rumble, you name it, we're on there.

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Cary Hall

And the YouTube platform America's Healthcare Advocate. My producers in studio. Mr. Dave Thiessen behind all the cameras today. The man who puts all this together gets it up on all the podcast and YouTube platforms. And Garner Cowdrey here from Cumulus, a recording today's show and doing all the audio work so we can bring this out to all of our affiliates across the country.

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Cary Hall

So in studio with me today, Carolee Steele and Maria Ahlers, from RPS Benefits by Design. Welcome back for the. I don't know what this the 50th show.

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Carolee Steele

We feel like an old married couple.

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Cary Hall

We've been doing this for a while. So what are we doing today? Well, there's a lot of chatter out there. Okay. That's about the best way I can put it about what's going to happen with ACA. And, you know, I'm seeing pieces in the media that are portraying, you know, what's going to occur and the changes that are going to happen and how they're going to impact people.

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Cary Hall

And unfortunately, there's a lot of false narrative out there. So I'm going to I'm going to step in here for a minute and kind of explain where we're at on the individual health insurance market on Obamacare and ACA, how we got here. Okay. And then what does that look like? So let's just start off with some facts, okay?

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Cary Hall

Between 2014 and 2019, benchmark premiums for ACA plans increased as much as 90%, 90%. Okay. And we'll talk about why here in a little while. Rural counties have been hit especially hard. 52% of the counties participating in Obamacare only had one plan, because the carriers either don't have the ability to do a network or they can't get access to care in those rural markets.

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Cary Hall

So there's another problem. All right. So federal subsidies and this is where it starts to become an issue. Federal subsidies are now at a $100 billion a year, 100 billion, which in ten years is $1.2 trillion. So what we've got here, all right, is we've got an unsustainable situation that cannot continue. And what prompted all this, what caused us to move from where this thing was originally designed, was the changes made in 2021 and on out, where we moved the poverty level up to 400% of the of the annual poverty level, which means we increased, increased the subsidies significantly.

00;02;47;09 - 00;03;11;17

Cary Hall

And that's where we had a huge number of people enrolled in these plans, because at that point, the subsidies' were up to as we as I just talked about, okay, billions of dollars that weren't planned for this was as a result of Covid. It was supposed to be temporary. But you know as well as I do, anytime you introduce a government program where you're handing people money, it's not going to be temporary.

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Cary Hall

Well, actually, it is this time because it's being pulled back. Okay. And what's happening is the Trump administration is bringing it back to what it was originally designed to do. Now, that's not what you're seeing in the press. That's not what you're hearing. You're hearing that the Trump administration is going to throw 8 million people off of the Medicaid and ACA plans.

00;03;31;27 - 00;03;51;06

Cary Hall

Okay, I broke that down on another show. I'll very quickly just make sense out of this. Over 1.4 million of those people are illegal aliens, okay, that are on the plans like in California other places. And the remainder of those people that are going to be displaced on these plans are people that are going to lose those subsidies up to 400%.

00;03;51;08 - 00;04;13;17

Cary Hall

The plan was when President Obama, qnd this passed. Okay. And John McCain was the passing vote in the Senate, pushed it through. The idea was to give people subsidies up to 150 to 200% of the poverty level, people that actually needed subsidies to get health insurance. It was never designed to go to 400% of the poverty level. That's where it's at, and that's what's going to change.

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Cary Hall

So Carolee, there going to be some big disruptions in the marketplace.

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Carolee Steele

Huge, huge, huge. And just to reiterate, American Rescue Plan was enacted in 2021. So they had basically, like you said, enhanced subsidies. So they really weren't like true to what they were prior to. So with that, now if anybody doesn't know what subsidies are, that's monies that the government gives to the carrier on your behalf for part of that premium.

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Carolee Steele

So your premium then is decreased because of the subsidy that you that they're giving to the carrier. Okay. So currently enhanced subsidies are scheduled to expire at the end of 2025. So what does that mean? That means starting in 2026, millions could see just a huge jump, an increase in the marketplace plans because their subsidy will go down.

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Carolee Steele

And so, so from there you have a decreased financial assistance. So and then from there what do you do from there? You've got to come to one of us so that we can figure out how to pivot or be able to look at other companies. You may end up having to not have the exact doctor you want if you're going, if you can afford something that has a more narrow network, you're going to have to probably do that.

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Carolee Steele

Aetna is also dropping out of that market.

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Cary Hall

1 million people.

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Carolee Steele

Well, yeah, 10,000 members in the metro here. So Aetna has 10,000. So and they were kind of really Saint Luke's driven. So you know going back we're going to have to look at other carriers that might contract with Saint Luke's. And so that's where that's where it comes for us.

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Cary Hall

So what you and we're referring here to the Kansas City market, the show broadcast nationwide. This is happening in every market across the country. Correct. We're just using this as an example. But just moving from 400% of the poverty level back to 150 or 200%. That's where the big change is going to come, is I said, when President Obama passed this bill, it was never designed for that piece of the marketplace, but it was enhanced by the Biden administration when they moved this up to 400% of the poverty level.

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Cary Hall

And with the huge influx of people, you have 24 million people on these plans now that's going to change. And what's happening is so let me give you some examples of a couple things to kind of put this in perspective. If you're a 52 year old male, but I'll use an example of a realtor here in Leawood, Kansas, 52 year old male wife, the same age, one child made way too much money to get a subsidy, make him a significant salary, is a very successful realtor.

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Cary Hall

His premium is $3,100 a month, $3,100 a month. He moved to a GigCare plan. Okay, which is the plan offered by Detego. Okay, a GigCare plan for $1,300 a month. Why? Because we're competing in the marketplace in a different way. What's happening is that people that aren't getting subsidies are going off these plans because they become unaffordable.

00;07;13;25 - 00;07;31;21

Cary Hall

Right. And then what's going to happen? What's starting to happen now is what we call a death spiral. You're going to and this is being referred to in the media in a lot of places, the healthy people are coming off the plans. Yes they are. They're going to look for alternatives like GigCare. They're going to look for alternatives on the group side like ICHRA.

00;07;31;26 - 00;07;50;02

Cary Hall

And we'll talk with Maria about that a little later on. Okay. But there are marketplace solutions out there that are going to come into play. They're going to start to change the dynamic here. But this all centers around the fact that this was never designed, okay, to be a completely government run system. Oh, are there are people that wanted that?

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Cary Hall

You bet there are. The, you know, the group people in this country that want Medicare for all. And they think that solution, that's where they were hoping this is going to go. What they didn't count on was that the Trump administration was going to come in and they were going to change this back to what it was originally meant to be.

00;08;05;02 - 00;08;26;27

Cary Hall

So that's where we're at. Okay. And then when I come back from the break, I'm going to talk with two experts now, and we're going to start talking about what can you do to prepare yourself. I don't care where you're at in the country. This is happening. Okay. So what can you do to prepare yourself so that you're not caught up in a trap and you can't make a decision to solve the problem?

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Cary Hall

That's going to make sense for you economically, and going to give you the kind of coverage you need. That's what we're talking about here today, and that's the message we're trying to get out to. Everyone is be prepared. This is coming. It's going to be like a tsunami. There going to be a lot of people displaced off of these plans are going to be looking for alternatives.

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Cary Hall

And so how do you deal with that? What's the best solution for that? That's what we're here to talk about today and show you how you can do that and make sense of it for you, your family. If you're an employer, what do you need to be looking at? Because the ACA plans for small group are going to get hit hard, it just as hard as the individual plans are.

00;09;02;12 - 00;09;25;00

Cary Hall

It's not harder in some cases. So how are you going to prepare for that? Stay tuned. We'll be right back after the break. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast across the USA. Stay right there. We've got more.

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Cary Hall

To. Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA here on the HIA Radio Network. Want to say hello to our affiliate in Pensacola, Florida, WNRP, AM 1260 and 95.3FM. We're on 8:00 in the morning there on Saturday mornings in the Pensacola area. Happy to be part of that family in Pensacola, Florida.

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Cary Hall

Welcome on board. Glad to have you. In studio with me today. Carolee Steele and Maria Ahlers from RPS Benefits by Design. We're here to talk about all the changes that are coming and they are coming, which is why we're doing this show today well ahead of what we're going to anticipate in the open enrollment period. The changes that are coming to ACA, we've got changes coming in Medicare.

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Cary Hall

That's going to be a different show, but we really want to focus on ACA today, Obamacare, ACA. Whatever you know it as. Both on the small, on the small group market and on the individual market. How is it going to impact what's it going to look like? So I'm going to roll through some of the numbers here just to give you some idea.

00;10;30;10 - 00;10;53;08

Cary Hall

So these are the carriers. We're just going to use the KC metro. But again I'm doing this. So it's a you know, it's a microcosm of what's going on. But this is going on around the country. I'm just using this example. So Celtic Insurance is going to have a 24.4% increase. Medica insurance 29.2% increase Oscar 11.7% increase.

00;10;53;15 - 00;11;16;24

Cary Hall

United Health Care 10.7. Guess what? Blue Cross and Blue Shield of Kansas City -4.4 I'm going to repeat that blue Cross and Blue shield of Kansas City -4.4. So Blue Cross Blue Shield of Kansas City is coming in with a different plan in the marketplace. We're going to talk about that is the solution. But to give you an idea there's a lot of disruption coming up.

00;11;16;25 - 00;11;40;17

Cary Hall

And when people lose these subsidies you know, how are they going to respond to that? How is that going to work? Well, when you're looking at these kinds of increases which have nothing to do with the subsidies, these are just the increases based on the fact that these carriers are having claims, they're outstripping what they're bringing in, which is why Aetna pulled out of the market after losing over $2 billion last year.

00;11;40;19 - 00;12;01;17

Cary Hall

On the individual health insurance side. They just couldn't do it anymore. Okay. So you have two dynamics here. One is reduced subsidies, the other is increasing costs, that are associated with ACA and that's impacting the marketplace. So let's talk about this. So it looks like you're going to see significant increases across the board.

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Carolee Steele

And that to your point it's going to stack. So you've got increased premiums. And then you have lowered subsidy. So that's going to stack on there to where their premiums are going to be significantly higher because of that.

00;12;15;23 - 00;12;38;08

Cary Hall

So blue cross and blue Shield of Kansas City not unusual that they would be innovative and figure out a way to do this. The, the, you know, the individually, operated not for profit Blue Cross plans seem to have an ability to do things like this, right? Do innovative pieces. And so as a result of that, you know, here we're looking at the only one in the marketplace.

00;12;38;11 - 00;12;49;20

Cary Hall

It's going to have a -4.4. So talk about this new plan that they're going to offer. And yes, people are going to have to make some adjustments. But you're going to have a Blue Cross plan. Let's talk about that.

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Carolee Steele

And there is something to say about that with local customer service and things. That is a huge plus. So as far as like some of their plans currently have like a Blue Select Plus that may pivot to a Blue Select. So the market mean that the network is going to be a little bit less, but the premium is also going to be less.

00;13;08;09 - 00;13;16;29

Carolee Steele

So you have to kind of look to see who are your non-negotiable doctors and who do you want what where can you kind of sacrifice as far as going elsewhere.

00;13;16;29 - 00;13;29;21

Cary Hall

So you're going to see access narrowed. So you're going to have a narrow network okay. But you're still going to have a great benefits program, but you're going to have to it, you know, you may have to make a change in doctors to stay in that network.

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Carolee Steele

The Blue Select and Blue Select Plus are still pretty robust, except for but the new new one that they're coming out with has a very narrow network, but a very low premium. And so that is kind of they're innovative, you know, to be able to add something to the market because they know this is coming. They know that people, you know, are going to be kind of with those enhanced subsidies going away, they're going to have sticker shock for sure.

00;13;55;16 - 00;14;01;22

Carolee Steele

And so that's why they've developed this new plan, you know, and so they're going to be able to offer other options.

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Cary Hall

So that's one solution that's going to be in the marketplace. Let's talk about another one. GigCare which is offered by Detego. I gave the example in the opening monologue about the real estate broker here. So if you're making 150, 200 and $300,000 a year, I know there are a lot of you out there to do.

00;14;20;22 - 00;14;33;05

Cary Hall

And you can afford to do something different. Maybe you don't want to pay $3,100 a month for three people on plan, and you come to a plan like GigCare. This is designed specifically for 1099 people or.

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Carolee Steele

W2 people that do not have coverage offered, you know, from their company. So they do not or their wife. Yes. Right.

00;14;39;17 - 00;14;43;15

Cary Hall

So there there is a solution, that is significantly different.

00;14;43;16 - 00;15;08;12

Carolee Steele

Correct. And the all of the marketplace plans, well, at least in the KC Metro, but very much, across the nation as well, are EPO's. That's exclusive provider organizations. So there is no network outside of, you know, you don't have to have like an HMO, you don't have to have referrals, but there's no out of network coverage except for emergency.

00;15;08;19 - 00;15;36;07

Carolee Steele

And so that's where GigCare, you know, they have those, but they've got Blue Card. So anywhere you go in the United States that offers like Preferred Care Blue, etc., you can go to those doctors. I have people that travel to Florida. They're doctors are in there. Here, their doctors are in there and that's huge because, those EPO's, especially with restricted networks, are going to make a difference, that you're going to have to pivot and look elsewhere to see how you can get covered.

00;15;36;08 - 00;15;51;09

Cary Hall

So the GigCare plans have an EPO model and they have a straight PPO model. And you're referring to the PPO model is the Blue Card model, which is anywhere in the country by the way, you may not know this yet, so I'll announce that here on this show, we are now going to have the Aetna network.

00;15;51;09 - 00;16;00;20

Cary Hall

And the Cigna network is options under GigCare. So it'll be an option for Aetna, Cigna and Blue Cross and Blue Shield which is going to make a big difference right.

00;16;00;20 - 00;16;18;06

Carolee Steele

Even if you have an EPO though like if you're like we're in the Kansas City metro, it's Blue Cross and Nebraska network. So Blue Card will go anywhere here. So even though it's a PPO and EPO, there's a little more flexibility as far as a network is designed when you're outside with that Blue Card.

00;16;18;13 - 00;16;35;08

Cary Hall

So again you know you're seeing some differences here. There are solutions out there. You're looking at the solution here from Blue Cross Blue Shield to Kansas City. We're talking about this GigCare solution. When we come back from the break I'm going to talk to Maria Ahlers about a small group solution called ICHRA. What does that mean. How does that work?

00;16;35;08 - 00;16;55;18

Cary Hall

How can that benefit employers? So we'll talk about that and some of the other plans that are out there that are a little different in their model, but still offer good coverage for people so they can get these cost controls in line and make sense out of it. So I think there are solutions, but they're just not going to be the solutions that have been out there for the last five years.

00;16;55;18 - 00;17;13;07

Cary Hall

And if you're a lazy broker and you don't want to get off your rear end and look at some of the other options, you can't just put this spreadsheet down and say, here's, here's all, here's the deal. Cross United, Cigna, Aetna (no longer) but plans and pick your poison. You have to you have to be innovative enough to look at opportunities.

00;17;13;12 - 00;17;17;19

Carolee Steele

You just have to look outside the box and see what there is out there. And that's where we come into play.

00;17;17;19 - 00;17;36;17

Cary Hall

And that's what these folks do. I don't care where you're at in the country if you need help. 877-385-2224 ask for the lovely Carolee Steele if it’s on the ACA side or the Medicare side. If it's on the group side, Maria Ahlers can certainly help you, or are one of the other folks there will be happy to help you on the group side.

00;17;36;20 - 00;17;59;20

Cary Hall

But they can make a difference because they're willing to step out of the box and look at things that are different . 877-385-2224 or the website rpsbenefitsbydesigninc.com. Go to the website, send them an email if you want help. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting coast to coast across the USA.

00;17;59;21 - 00;18;11;22

Cary Hall

Stay right there.

00;18;11;24 - 00;18;29;23

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA. All these shows are on our podcast platform. So Spotify, SoundCloud, TuneIn, you name it we’re on there. Rumble, all of them. And the YouTube channel. Dave Thiessen pulls all this together, gets it up there for you and does a great job with this.

00;18;29;23 - 00;18;55;24

Cary Hall

So you can tell somebody about this. Hey, maybe it's your employer and you guys are not aware a lot of people are not aware of what's coming. Have them go listen to the podcast, have them go look at the YouTube video so they understand what's going to happen on the employer side. And if it's, you know, we're talking about the individual health insurance, you know, if this is your husband, your wife, whatever the case may be, your family, you might want to have a conversation with them, have them take a listen to this and look for some alternatives.

00;18;55;24 - 00;19;19;11

Cary Hall

If you just want some help and a consultation. 877-385-2224 ask for Carolee. If it's on the individual side. If it's on the group side to ask for Maria, callers 877-385-2224 anywhere in the country okay, doesn't matter where you are, they're happy to help you. The website is rpsBenefitsByDesignInc.com if you want to go up on the website.

00;19;19;17 - 00;19;24;22

Cary Hall

All right. So the the changes on verification. Let's get that first. And we're going to go right to group.

00;19;24;23 - 00;19;51;27

Carolee Steele

Give it on okay. Consumers are required to verify their eligibility for a subsidized plan each year now. Or they have an additional $5 monthly premium. And that's new versus previous years. And also they have to verify prior to their, plan starting that they have a proof of a qualified life event. Like if you're losing employer coverage, you have to provide proof first before the plan will start, not after.

00;19;51;29 - 00;20;12;12

Cary Hall

Okay. So this is this has been coming for some time because we had people. I did a piece on this when I was, when I did the Medicare show. You've got people on the ACA plan that are getting big subsidies. And they're also over here on the Medicaid plan, two plans, same person. Okay. So there's a lot of fraud and waste going on here because they weren't verifying anything that's changing.

00;20;12;12 - 00;20;30;21

Cary Hall

Correct? Okay. They're going back to the way it was originally set up, which when you originally went on to an ACA plan, you had to present your tax return to get a subsidy. Well, when they opened this up in 2021, the all the rules went away and it flooded this place. That's why you got 24 million people on here now.

00;20;30;26 - 00;20;51;19

Cary Hall

And there's going to be some shock and awe as a result of the changes. All right. Let's switch gears. So the small employer is the one that gets punished the most, Maria. In this marketplace, you know, the big employers 100 lives and above, we were talking about on break. You can go to the Pareto Captive, you can go to Berkeley, you can, you know, go to one of our plans on Detego that are in the captive model.

00;20;51;19 - 00;21;03;00

Cary Hall

And you can lower your costs and make a lot of sense. The small employer, those 50 and below they’re other ones are getting clobbered. What are the solutions to them like ICHRA and you talk about some of those.

00;21;03;00 - 00;21;33;04

Maria Ahlers

Absolutely correct. Yes. There are creative solutions outside of what we call the BUCAs, right. The Blue Cross, Blue Shield, United, Cigna and Humana. ICHRA, as you mentioned, Cary. ICHRA stands for Individual Coverage Health Reimbursement Arrangement. And what that provides is instead, when you're on a when you're on one of the big BUCA plans, your employer contributes, at least 50% to the premium.

00;21;33;06 - 00;21;57;06

Maria Ahlers

What small business employers are doing is sometimes that's a huge cost for them. When they have to pay at least 50%, most of them will pay more because they want to be competitive in the market. So now what they're doing is we're looking at ICHRA where the employer sets a percentage or a flat rate of what they want to contribute to an employee for their premium health care.

00;21;57;09 - 00;22;23;18

Maria Ahlers

Now, what that employee does is that employee then takes that amount. So say your employer wanted to contribute $300 a month to your premium. You now have $300 a month to go on your own and find your own plan. We can help do that. We have partnerships where we will set it up on a platform, with the amount that the employer wants to to contribute.

00;22;23;18 - 00;22;47;09

Maria Ahlers

Then the employee goes on to the platform, they know they have the $300. They can shop with different carriers with different plans. They can pick the amount of their deductible. They can do the PPO, they can do a high deductible health plan, and then they can enroll and they can see what their coverage is. And then that $300 is contributed to their monthly rate, and then the rest is taken care of by the employee.

00;22;47;09 - 00;23;06;28

Cary Hall

So the beauty of this is instead of painting everybody with one brush, right. So you got employees that are 25 years old and you got employees that are 60 years old and they're all on the same plan. Well, now they don't all need the same plan. No 60 year old doesn't need maternity benefits, and they don't need access to children's mercy.

00;23;07;01 - 00;23;25;00

Cary Hall

So for them to go to this new narrow network Blue Cross plan maybe would make a lot of sense. Okay. But in order to navigate that, they have to understand what it is. And that's where you all come in and say to the employer, hey, you, you put the subsidy together. We'll handle getting your people on the plans they need to be on.

00;23;25;01 - 00;23;25;12

Cary Hall

Right?

00;23;25;12 - 00;23;40;07

Maria Ahlers

That's right. You tell us how much you can afford within your budget. We set it up and then your employees go on there, and the plans are on there for them to see, from different carriers, different amounts, the network, and they pick what works for them.

00;23;40;10 - 00;23;59;10

Cary Hall

See you. I, I've said this is the thing I've used on this show for years, size 44 overcoat doesn't fit everybody. Okay, so this is exactly what I'm talking about. That gives the employer a fixed cost. That's the whole idea. And it gives the employee the freedom to go pick what they want.

00;23;59;17 - 00;24;00;23

Maria Ahlers

That's right. That's exactly.

00;24;00;23 - 00;24;01;21

Cary Hall

It makes a lot of sense.

00;24;01;22 - 00;24;27;04

Maria Ahlers

It does. And then the employees, if they need help deciding what plan works for them, that's where my team comes in and provides that individual consulting. Now, with RPS we also work with Carolee, where if we feel that an ACA plan may be more beneficial for them, then we'll refer them over to that to our Solutions team to do that.

00;24;27;07 - 00;24;32;24

Maria Ahlers

But it's a one stop shop, Cary. We'll figure out what the best plan is for your employees.

00;24;32;24 - 00;24;52;10

Cary Hall

Yeah. Don't you know, don't try to negotiate this yourself, okay? It's complicated. Believe me. I've been doing this for 30 years, and it's getting more complicated, not less complicated, because you got government right in the middle of this now, and trying to sort through all this to make sense out of it in the marketplace is difficult. Here's some other solutions that people are doing.

00;24;52;13 - 00;25;17;02

Cary Hall

We've got we've got some new direct primary care clinics here in Kansas City. Exemplar Care is part of Hy-Vee. They're opening up new clinics here. So what we're seeing is employers saying, you know what, I'm going to buy that direct primary care, unlimited access for my employee and their family. It's $91 a month, let's say, and then I'll go buy a high deductible plan.

00;25;17;05 - 00;25;24;10

Cary Hall

Let's talk about how would you marry those two up, like, because I know you're doing this, the HRA and the HSA talk about that, Maria.

00;25;24;10 - 00;25;58;17

Maria Ahlers

Yes, we can we can pick pieces from different, plans to make it work for our clients. So you can do a, as you mentioned, care. You can do a direct provider membership for, for every day to day, you know, the ear infections, the preventative, the annual wellness that could be for that. There are also providers that are there's also programs where you can do that virtually now and you just pay a monthly fee, and it covers all their day to day stuff as well as well as prescription.

00;25;58;19 - 00;26;21;05

Maria Ahlers

But then we can also offer what we call catastrophic plans, where if somebody gets diagnosed with a major medical condition, then you have the catastrophic coverage that can also help cover that. There's HRA where, employers can pay for first dollar coverage, or they can pay for the back end coverage. There's a HSA account we've heard, actually.

00;26;21;05 - 00;26;48;29

Maria Ahlers

Now people are very much a proponent of HSA where they're saving 20 to $30,000 already to cover their medical expenses. There is GigCare to help with the solutions? There's level funded. Most companies now are trying to get away from the ACA because they are they are age rated.

00;26;49;02 - 00;26;51;20

Maria Ahlers

Are they are set

00;26;51;23 - 00;27;10;11

Cary Hall

And you're going to see your employers that when you've got reasonably healthy groups are going to start looking for a way out. That's right. They want to get off. They want they've got to find something that works. This thing is not sustainable the way it is now. But as a broker you have to be willing to step outside the box.

00;27;10;14 - 00;27;17;24

Cary Hall

Yet be willing to listen to what somebody is dealing with. How do I solve the problem. And here's the set of solutions.

00;27;17;27 - 00;27;40;16

Maria Ahlers

There's so many solutions we can implement. You know, we've done a gap plan to help with the larger, high deductible health plans where we add that as a plan for our clients. And that helps cover the gap between the deductible between the two plans. There's just a lot of creative solutions.

00;27;40;21 - 00;27;47;28

Maria Ahlers

We just need to know what your needs are, what your pain points are, and let's get together and figure out the different options.

00;27;48;04 - 00;28;09;27

Cary Hall

Here's the thing, okay? You have to be, you've got to be proactive here. Don't wait until you know renewal hits you with a 25% increase. Or a 29% increase from Medica or Celtic or one of the other ones. Okay, now's the time to act. Start a consultation, give them a call, get ahold of Maria.

00;28;09;27 - 00;28;29;02

Cary Hall

Get Ahold of Carolee. 877-385-2224. It doesn't cost you anything to talk to these folks, okay? And they can help you get a solution. That's going to make sense, but you have to get in front of it, not do it. At the end of the situation where now you've got to renewal and you don't have any time to make a decent decision.

00;28;29;09 - 00;28;53;06

Cary Hall

So once again, 877-385-2224 or their website RPSBenefitsbyDesignInc.com. rpsbenefitsbydesigninc.com. When I come back we're going to explain HSAs so you understand how they work and these HRAs and how you can incorporate those and keep benefits for a major network, but have that benefit if you have a catastrophic illness.

00;28;53;11 - 00;29;09;22

Cary Hall

Stay tuned. We'll be right back after the break. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast across the USA.

00;29;09;24 - 00;29;29;25

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show, broadcasting coast to coast across the USA here on the HIA Radio Network. My producer, Mr. Garner Cowdery, behind the microphone. Dave Thiessen behind all the cameras. Putting all this together. For all of you out there in our audience, on our podcast channels, YouTube channels, and across the air on all of our terrestrial radio stations.

00;29;30;00 - 00;29;55;06

Cary Hall

In studio with me, Carolee Steele and Maria Ahlers from RPS Benefits by Design. We're telling you, get prepared. It's coming. It's going to be a tsunami. It's coming. Don't wait until you're caught up in it, okay? These people can help you navigate through. The sky is not falling. It's not the end of the world, okay? But you've got to prepare yourself and if you're the employer, for God's sake, pick up the phone and give these folks a call.

00;29;55;11 - 00;30;16;26

Cary Hall

If you're an individual and you're concerned and maybe you're one of those Aetna people, you're losing coverage altogether. Okay, well, give them a call. They're happy to help. 877-385-2224 they are experts. They do this nationally. Okay? 877-385-2224 or the website rpsbenefitsbydesigninc.com.

00;30;16;28 - 00;30;21;00

Cary Hall

You know, HSAs were introduced I don't know was it 15 years ago?

00;30;21;00 - 00;30;39;23

Cary Hall

Something like that. And it was a hard concept for people to grasp. Correct. But when you look at how they function versus how what I call the American Express Plan, where you have your American Express card, you don't have to you walk in and make a $10 co-pay and you're done. Well, those days are gone. Yeah, that's why the premiums are going through the roof.

00;30;39;29 - 00;30;46;19

Cary Hall

Let's talk about how the HSA works, why is it beneficial and why are a lot of people moving to those plans?

00;30;46;19 - 00;30;59;18

Carolee Steele

Well, I think it’s wonderful. I have an HSA. So what HSA is, is that you can put monies away every year toward, it's a certain amount depending on if you are single.

00;30;59;18 - 00;31;00;20

Cary Hall

It’s up to $6,300 a year.

00;31;00;20 - 00;31;24;16

Carolee Steele

Or a family, you can put that away. It's typically you've got to, everything comes out of pocket until you meet that deductible. And then there's a percentage for insurance. Typically the employer offers an HSA that is a reduced premium compared to the other standard traditional plans. So that was one good. It also, you can use that money.

00;31;24;16 - 00;31;26;03

Carolee Steele

It rolls over to the following year.

00;31;26;03 - 00;31;28;17

Cary Hall

So it's not a use it or lose it at the end of the year.

00;31;28;17 - 00;31;50;10

Carolee Steele

Correct, it's not a flex spending account. It is an HSA account. Yes. And this is really wonderful because if you have a family, your daughter needs to have her teeth pulled to get something for wisdom teeth pulled. You can use that as long as they're tax dependents in the family. You can use those HSA funds toward that as well.

00;31;50;10 - 00;32;00;04

Cary Hall

And here's the thing. When you put the money in there, it's a tax deduction. Right. So if you put $6,300 in there you just took $6,300 off of your tax liability.

00;32;00;04 - 00;32;00;18

Carolee Steele

Correct.

00;32;00;21 - 00;32;01;17

Cary Hall

It's a tax deduction.

00;32;01;18 - 00;32;02;09

Carolee Steele

That's huge.

00;32;02;09 - 00;32;04;06

Cary Hall

And Maria, once you hit a.

00;32;04;06 - 00;32;09;29

Maria Ahlers

Certain amount you can invest that money in the money market.

00;32;10;04 - 00;32;11;02

Cary Hall

I didn't know that.

00;32;11;02 - 00;32;11;13

Maria Ahlers

You can.

00;32;12;09 - 00;32;30;06

Cary Hall

So there's another option. Yeah. So the money stacks up. You get past your first year, you've got enough to cover the deductible coinsurance typically down the road. Okay. As you continue to add to it, you're building an account. And as you said you can invest that money Maria. So this is an opportunity individual side.

00;32;30;06 - 00;32;45;29

Cary Hall

So tax deductible going in tax free coming out. You can use it for more than health care. You can use it for dental. You can use it to buy glasses. You can use it for a host of different things right. You get a debit card. You have an HSA account. That's how it works. How does this work for employers?

00;32;45;29 - 00;33;03;15

Cary Hall

Now, Maria, in terms of you talked in the last segment, if you drop premiums 30%, the employer can afford to say, you know what, if you got an HSA, I'm going to go ahead and add another $100 a month to this for your HSA account to encourage people do it. Does that make sense?

00;33;03;17 - 00;33;20;00

Maria Ahlers

There's a lot of different strategies, Cary, that we work with our clients. We have clients where they do, a high deductible health plan, offer an HSA, and then they contribute 100% to the employee's HSA to help with their costs up to their deductible.

00;33;20;03 - 00;33;37;17

Maria Ahlers

We have clients that will, embed an HRA, which where they'll cover again, if your deductible is $3,000, that employer will cover, will decide they'll cover the first, maybe the first 1500 of your deductible, or they'll cover the back 1500 of your deductible.

00;33;37;21 - 00;33;58;09

Maria Ahlers

But these are creative strategies that we work with our clients to make it work for them, but yet provide them with comprehensive coverage for their employees. So yeah, there's there's it's it's all about strategy. And I think the point that you made earlier is we need to start on it proactively.

00;33;58;15 - 00;34;21;24

Maria Ahlers

Most employers will wait until they get their renewal. Well then we only got 60 days. And with that 60 days we have to strategize, look at different options, go to market, look at the financial analysis. The other piece to this that some of our clients don't, recognize that we've, put into play a lot is critical illness and accident and hospital indemnity.

00;34;21;27 - 00;34;26;17

Maria Ahlers

Those lines of coverage help with the medical costs as well.

00;34;26;20 - 00;34;30;23

Cary Hall

So there are ways to blend those in. And there those are relatively inexpensive.

00;34;30;23 - 00;34;31;18

Maria Ahlers

Relatively inexpensive.

00;34;31;20 - 00;34;53;17

Cary Hall

I had a cancer plan for I don't know how many years it was. I had a bulk cancer plan of $50,000, and the way it worked was, I hate Aflac, just so we all know I like ducks. I prefer it with orange sauce. Yes, but you know, I don't like the Aflac model because what they do is you have to send in your claims and then they reimburse you.

00;34;53;23 - 00;35;02;01

Cary Hall

The model that I had was once I was diagnosed with cancer, and the actual diagnosis went into the carrier. I got a check three days later, period.

00;35;02;01 - 00;35;06;11

Maria Ahlers

And you can spend it on whatever you like.

00;35;06;11 - 00;35;06;19

Cary Hall

Whatever I wanted.

00;35;06;26 - 00;35;20;06

Cary Hall

If wanted to go sit on a beach in Mexico and decide, okay, this is where I'm going to finish it up. That's right. I've got terminal cancer. That was my money to do what I want with. But that was a very inexpensive policy. But it gave me peace of mind.

00;35;20;08 - 00;35;23;12

Maria Ahlers

Because we know bills don't stop just because you're in the hospital. No.

00;35;23;13 - 00;35;40;17

Carolee Steele

And to piggyback on that, as far as having your, like a critical, like, cancer, stroke and heart, you may have you may have a Medicare supplement. So you don't have a lot of medical out-of-pocket, but you may have to go to Mayo Clinic, and you're going to have to stay in a hotel, and you're going to have to fly there, and you're going to have to do all that.

00;35;40;21 - 00;35;44;14

Carolee Steele

So that is also used. That money can be used for that as well.

00;35;44;14 - 00;36;01;28

Cary Hall

Yeah. So I think what we're trying to say here is we're wrapping this up today. And thank you both to me and Maria and Carolee. You know, it's great to have experts in studio that can really walk you through this stuff. It's complicated, but this is why I do these broadcasts. And I bring people on here that can explain this to make sense out of it.

00;36;02;00 - 00;36;24;00

Cary Hall

So you're looking for a solution? You heard Maria just say this. Here's what happens. Everybody waits until those renewal notices hit or ACA open enrollment starts and then they start calling. Well, you're not the only one okay. You know. Yeah. The phones are melting down. I remember doing this back when I ran Benefits by Design.

00;36;24;07 - 00;36;45;24

Cary Hall

And literally the phones would be melting down with people in a panic trying to get this done. This year's going to be worse. That's why I'm doing this show way ahead of time. Okay. So you know that it's coming. And prepare yourself. If you're an individual, you need help. Get ahold of Carolee, 877-385-2224. If you're an employer, you just heard Maria walk through how they do this.

00;36;45;29 - 00;37;06;23

Cary Hall

They do a full blown analysis. This is a come in and lay a spreadsheet down. They come in, they do a full blown analysis, come back to you with a series of solutions, and then you pick the one you think makes the most sense. That's what I'm suggesting you do. 877-385-2224 is their phone number. Their website is rpsbenefitsbydesigninc.com.

00;37;07;00 - 00;37;24;02

Cary Hall

If you are one of the folks that are facing these kinds of renewals and what's happening, now's the time to reach out to them. And now I leave you with this thought from Albert Einstein, the one who follows the crowd they usually get no further than the crowd. The one who walks alone will likely find himself in places no one has ever been.

00;37;24;05 - 00;37;40;01

Cary Hall

Remember, friends it’s a funny thing about life, if you refuse to accept anything but the very best, you most often get it. Thank you for listening to America's Healthcare Advocate Show, broadcasting coast to coast across the USA here on the HIA Radio Network. Goodbye America.